Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 132

Sexuality is closely linked to health at an older age, and people who consider themselves to be in good health are more likely to have an intimate relationship and engage in sexual activity with a partner.⁵ Older adults who are in good to excellent health may gain up to seven additional years of sexual activity compared to those in fair or poor health.⁴

A number of diseases have known impacts on sexual activity. Diabetes is associated with reduced sexual activity in women and erectile dysfunction in men and is also associated with less frequent masturbation in both men and women.⁵ Neurological conditions, including multiple sclerosis, Parkinson’s disease, and peripheral neuropathy, can affect sexual functioning. Renal failure is associated with sexual dysfunction in both men and women due to physical changes and psychological changes such as negative self‐image and anxiety.³⁷ Urinary incontinence is associated with worrisome reduced sexual activity and function in both men and women.³⁸ Depression and sexual activity are closely linked, with some evidence that older adults who are sexually active and report having more frequent and better‐quality sex have better mental health outcomes and higher quality of life.^1,3 Conversely, older adults with increased anxiety report more sexual difficulties and lack of interest in sexual activity.^39,40

Hip arthritis pain can limit mobility during sexual intercourse, but this may be mitigated by oral pain medication and changing of positioning. For patients who have undergone total hip replacement, rehabilitation facilitated by physical therapists can help improve pain, range of motion, and self‐confidence during sexual intercourse.⁴¹ Other disorders such as prior stroke or post‐polio syndrome may result in impaired mobility. Physical therapists or sex‐positive counsellors can provide patients with assistance in sexually functioning with impaired mobility. Additionally, a wealth of online resources and forums are available to patients with disability.

Studies have shown high levels of concern about sexual health among survivors of breast and prostate cancer, with prostate cancer survivors being most concerned about being able to satisfy their partners, and breast cancer survivors most concerned regarding changes in their bodies and sexual function.⁴² Prostate cancer treatment, including surgery, radiotherapy, and brachytherapy, can cause urinary incontinence and erectile dysfunction.^43,44 Frequent issues among survivors of breast or gynaecologic cancers include dyspareunia, vaginal dryness, and loss of libido. Other issues affecting patients with breast cancer include pain, grief, altered body image, self‐perception, and fatigue.⁴⁵ A number of barriers to addressing unmet needs exist, including oncology clinicians’ focus on treating and monitoring the cancer itself, feelings of embarrassment on the part of patients, and logistical issues such as busy clinics and lack of resources.⁴⁶